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ATRIAL FIBRILLATION

Use of ibutilide in cardioversion of patients with atrial fibrillation or atrial flutter treated with class IC agents

Richard H. Hongo, MD^*, Sakis Themistoclakis, MD, Antonio Raviele, MD, Aldo Bonso, MD, Antonio Rossillo, MD, Kathryn A. Glatter, MD, FACC, Yanfei Yang, MD^* and Melvin M. Scheinman, MD, FACC^*,*

^* University of California, San Francisco, San Francisco, California, USA
Umberto I Hospital, Mestre-Venice, Italy
University of California, Davis, Davis, CaliforniaUSA

Manuscript received March 30, 2004; revised manuscript received May 5, 2004, accepted May 11, 2004.

^* Reprint requests and correspondence: Dr. Melvin M. Scheinman, Section of Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Avenue, MU-East 4S, Box 1354, San Francisco, California 94143-1354 (Email: scheinman{at}medicine.ucsf.edu).

OBJECTIVES: We sought to assess the efficacy and safety of ibutilide cardioversion for those with atrial fibrillation (AF) or atrial flutter (AFL) receiving long-term treatmentwith class IC agents.

BACKGROUND: Attenuation of ibutilide-induced QT prolongation has been observed in a small number of patients pretreated with class IC agents. The clinical significance of the interaction between ibutilide and class IC agents is unknown.

METHODS: Seventy-one patients with AF (n = 48) or AFL (n = 23), receiving propafenone 300 to 900 mg/day (n = 46) or flecainide 100 to 300 mg/day (n = 25), presented for ibutilide (2.0 mg) cardioversion.

RESULTS: The mean durations of arrhythmia episode and arrhythmia history were 25 ± 48 days and 4.4 ± 6.4 years, respectively. Sixty-five patients (91.5%) had normal left ventricular systolic function. Twenty-three of 48 patients (47.9%; 95% confidence interval, 33.3% to 62.8%) with AF and 17 of 23 patients (73.9%; 95% confidence interval, 51.6% to 89.8%) with AFL converted with mean conversion times of 25 ± 14 min and 20 ± 12 min, respectively. There was a small increase in corrected QT interval after ibutilide (from442 ± 61 ms to 462 ± 59 ms, p = 0.006). One patient developed non-sustained polymorphous ventricular tachycardia and responded to intravenous magnesium. Another developed sustained torsade de pointes and was treated effectively with direct-current shock and intravenous dopamine.

CONCLUSIONS: Our observations suggest that the use of ibutilide in patients receiving class IC agents is as successful in restoring sinus rhythm and has a similar incidence of adverse effects as the use of ibutilide alone.

Abbreviations and Acronyms   AF = atrial fibrillation   AFL = atrial flutter   CI = confidence interval   ECG = electrocardiogram/electrocardiographic   EF = ejection fraction   IKr = delayed rectifier potassium current   INa = sodium current   LV = left ventricle/ventricular   QTC = corrected QT (interval)   SR = sinus rhythm

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